A comparative study of knotless versus knotted transscleral suture-fixated intraocular lens implantation

• Published in: Indian journal of ophthalmology 2022-01, Vol.70 (1), p.131-137
• Main Authors: Yilmaz, Sami, Mavi Yildiz, Aysegul, Avci, Remzi
• Format: Article
• Language: English
• Subjects: Acuity; Astigmatism; Comparative analysis; Complications; Cornea; Edema; Eye; Eye lens; Humans; Intraocular lenses; Lens Implantation, Intraocular; Lenses, Intraocular; Methods; myopic shift; Original; Polymethylmethacrylate; Postoperative; Postoperative Complications - epidemiology; refraction; Retrospective Studies; Sclera - surgery; scleral-fixated intraocular lens; Statistical analysis; Surgery; Suture Techniques; Sutures; Suturing; Visual perception
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_551_21

Purpose: To compare functional outcomes and complication rates of two scleral fixated intraocular lens implantation (SFIOL) techniques. Methods: In this retrospective study, there were 30 eyes of 30 patients who underwent SFIOL implantation for dislocation of the IOL or crystalline lens. Group 1 (n = 17) comprised patients who received scleral-fixated polymethylmethacrylate (PMMA) IOL implantation through a self-sealing sclerocorneal tunnel with the suture burial technique, and group 2 (n = 13) comprised patients who received scleral-fixated foldable acrylic IOL implantation with a cartridge using a self-sealing clear corneal incision (CCI) with knotless Z-suture technique between 2014 and 2019. Surgical outcomes concerning safety, efficiency, visual function, induced astigmatism with vector analysis, and complications were compared. Results: The indications were dislocated crystalline lens (n = 5/30), dislocated IOL (n = 17/30), and dropped nucleus (n = 8/30). The mean follow-up time was 50.65 ± 14.02 months in group 1 and 15.69 ± 3.71 months in group 2 (P < 0.001). The postoperative visual acuity improvement was statistically significant in both groups (P < 0.001). Surgically induced astigmatism was significantly higher in group 1 (2.68 ± 1.04 D) compared with group 2 (1.6 ± 1.0 D) at month 12 (P = 0.001). Postoperative complications included suture exposure (n = 1 in group 1) and cystoid macular edema (n = 1 in group 1; n = 1 in group 2). Conclusion: Both SFIOL techniques are safe and effective in the absence of adequate capsular support. However, the knotless Z-suture technique appears to be superior to the suture burial technique with regard to suture exposure-related complications. In addition, self-sealing CCI appears to be superior to self-sealing sclerocorneal tunnel with regard to surgically induced astigmatism.